Permit CITY TIGARD MECHANICAL PERMIT
I - A DEVELOPMENT SERVICES PERMIT #: MEC2002 -00226
" , IJ 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/22/03
PARCEL: 2S115BD -02600
SITE ADDRESS: 16875 SW PACIFIC HWY
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 1
OCCUPANCY GRP: M VENTS W/O APPL: 0 VENT SYSTEMS: 1
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML.INCIN:
MAX INPUT: 100,000 BTU 15 - 30 HP:. REPAIR UNITS:
FIRE DAMPERS ?: N 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: M 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: 1 <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 2
Remarks: New 2,600 sq ft gas station/convenience store. Mechanical valuation is $2,206.00.
Owner: FEES
SPACE AGE FUEL INC Description Date Amount
PO BOX 607 [ MECH] Permit Fee 10/22/03 $72.50
GRESHAM, OR 97030 [MECPLN] Plan Rev 10/22/03 $18.13
[TAX] 8% StateTax 10/22/03 $5.80
Phone: 503- 665 -5693 [MECPLN] Addl Pln Rv 10/22/03 $62.50
Contractor: Total $158.93
REQUIRED INSPECTIONS
Phone: Gas Line Insp
Mechanical Insp
Reg #: Duct Inspection
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
Issued By: .euif4,t..01-/
1 2•_6 " iGL b Permittee Sign ature: i/ i /
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
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Mechanical Permit Application _
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Date received: 3 � Permit no.•
F.:, / i' City of Tigard
b P roject/appl. no.: Expire date: •
City of Tigard Address: 13125 SW HalI Blvd, Tigard, OR 9722 issued: B Receipt no.:
Phone: (503) 639 -4171 I
Fax: (503) 598 -1960 JUL 15 2002 Case file no.: Payment type:
Land use approval: € ; ; . , : _ �,) Building permit no.:
n r 1,rrt - t/ , 07, .
" TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory CommercialJindustrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 16,8?, g W eG 14 G rry Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mech cal materials, equipment, labor, overhead,
Tax map /tax lot/account no.: �,�- j 1,017/ � r profit. Value $ g • CV .
Lot: (Block: Subdivision: 'See checklist for important application information and
Project name: Qet= jurisdiction's fee schedule for residential permit fee.
City /county:. _ ffy , ,i - „,,, ': • - 7• 1 & 2 FAMILY DWELLING PERMIT FIE SCHEDULE
Description and ocation of work on premises: • ;d AND COMMERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE
C-CN.Vax[[ca[r� `52iZir . 77 .s/?4Ca. Fee(ea.) Total
Est. date of completion/inspection: //- / . z,Z Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
space insulated? ❑Yes ❑ No Air conditioning (site plan required)
Is existing p Alteration of existing HVAC system
M ECI IAN ICAL CONTRACTOR Boiler /compressors
r--Q State boiler permit no.:
Business name: TM? HP Tons BTU /H
Address: Fire/smoke dampers/duct smoke detectors
City: I State: I ZIP: Heat pump (site plan required)
Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H
CCB no.: Including ductwork/vent liner ❑ Yes ❑ No
Install/replace/relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace .
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: 1,.,, ,4F,4 c Chillers HP
Address: pc -( 4oa-7 Compressors HP
Environmental exhaust and ventilation:
City: G p I State: I ZIP: t 7 Appliance vent
Phone: , c , Fax:64 E -mail: Dryer exhaust
OWNER Hoods, Type If H /res. kitchen/hazmat
hood fire suppression system
Name: leg 4lir 'L Exhaust fan with single duct (bath fans)
Mailing address: p, � State: ZIP: 97030
Exhaust system apart from heating or AC
I � J Fuel piping and distribution (up to 4 outlets)
(L �
City: G Type: LPG NG Oil
Phone: a - Fax:665 - / E - mail: Fuel pi iin additional over 4 outlets
Process pj iping (schematic required)
Number of outlets
Name: Y / —' Other listed appliance or equipment:
Address: c311 R * - Decorative fireplace
City: f' 603. -L_LO State: ti) I ZIP: 832 ( Insert -type
Phone: ZClj-4- 7A-4413 I Fax: Z3-47f , • ••: : 461-7 Woodstovelpelletstove
�_;� Other:
Applicant's signa •
,/% Da te: r OZ Older.
Name (print): _,� m ?
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ '7
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at 25 %) $ IPA . 13
Expires within 180 days after it has been
State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount
440 -4617 (6/00lCOM)
MECHANICAL PERMIT FEES • .
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: - Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
' fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. footnotes below. Comp* **
7) <3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: to 1K BTU 14.00
3-
Value Total 8) 3 -15 HP; absorb
unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955 5 9 ) 15 -30 HP; absorb
ducts & vents unit .5-1 mil BTU 35.00
Furnace > 100,000 BTU including 1,170 10) 30-50 HP; absorb
ducts & vents I 1170 unit 1 -1.75 mil BTU 52.20
Floor furnace including vent 955 11) >50HP: absorb
unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955
12) Air handling unit to 10,000 CFM
floor mounted heater
10.00
Vent not included in appl ca
permit W Z., Z., ac �,� 445 l 4/64-- 13) Air handling unit 10,000 CFM+
17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan connected to a single duct
3-15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU
15-30 hp; absorb. unit, 501k to 1 2,310 16) Ventilation system not included in
mil. BTU appliance permit 10.00
30 -50 hp; absorb. unit, 3,400 17) Hood served by mechanical exhaust -
1 -1.75 mil. BTU 10.00
>50 hp; absorb. unit, 5,725 18) Domestic incinerators
17.40
mil. BTU
Air handling d 19 ) Commercial or industrial
Air handling unit to 10,000 m 656 type incinerator •
Air handling unit >10,000 cfm 1,170 69.95
Non - portable evaporate cooler 656 20) Other units, including wood stoves
10.00
Vent fan connected to a single duct I 44 6 +go 21) Gas piping one to four outlets
Vent system not included in • 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: • $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 - 8% State Surcharge $
inserts, etc. •
Gas piping 1-4 outlets I 360 '2,A.,Q
Each additional outlet / 63 25% Plan Review Fee (of subtotal) $
Required for ALL commercial permits only
TOTAL COMMERCIAL TOTAL RESIDENTIAL PERMIT FEE: - $
VALUATION: •
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours) .
$72.50 per hour.
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge-one-half hour) $72.50 per hour
* State Contractor Boiler Certification required for units >200k BTU.
* 'Residential A/C requires site plan showing placement of unit.
is \dsts \forms\mech- fees.doc 10/11/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
,. BUP
Received ti ' 1.' Date Re. ested 27/ 7 AM PM BUP
Location _ _ c..1 Suite c)- .'y0
Contact Person / -Q-� -e Ph ( ) 51C t91 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner It C.-2 j 4 ELC
Footing (�
ELC
Foundation Access: / ri w4 ELR
-
Ftg Drain eff LeLed l
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors W . 5) 533 - CZ 9 -575
Ext Sheath/Shear C.
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service _
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
oP st & Beam
Rough -In
Gas Line
Smoke Dampers
.aka
PART FAIL
E TRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date 2 /i 7/0 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL